Asian Americans tend to underutilize mental health services compared to other ethnic groups, with delayed treatment and higher attrition rates (Kung, 2003). When suffering from symptoms of mental illnesses, many underserved Chinese Americans seek help from their primary care physicians (PCPs) (Yeung et al., 2004a). In 2003, the applicant received a Career Development Award to study the effectiveness of Culturally Sensitive Collaborative Treatment (CSCT) for the treatment of underserved Chinese Americans with major depressive disorder (MDD) in primary care. The key elements of CSCT are active screening to increase recognition of depressed patients, culturally sensitive consultation by a psychiatrist and care management. Preliminary findings show that CSCT improves case recognition, facilitates engagement, and decreases the disparities of treatment among underserved Chinese Americans with MDD (Yeung et al., 2006; Yeung, 2007). This proposed study will investigate the feasibility and effectiveness of using Telepsychiatry-based CSCT (T-CSCT) to extend the CSCT model to underserved Chinese Americans in remote clinics. The specific aims of this study are: 1) To investigate whether telepsychiatry consultation is acceptable to underserved Chinese Americans with MDD and to their PCPs, and 2) To investigate the effectiveness of T-CSCT on improving treatment outcomes of underserved Chinese Americans with MDD in remote clinics. Subjects will be recruited by depression screening in primary care clinics and by advertisements to promote depression self-screening. Two hundred underserved Chinese American patients who screen positive for MDD will be randomized to receive either T-CSCT or Usual Care (UC). Treatment outcomes of patients in these two groups will be compared. This study will examine the acceptability and effectiveness of telepsychiatry- based culturally sensitive psychiatric treatment for underserved Chinese Americans with major depressive disorder. The goal is to increase access to mental health services and to decrease disparities in the treatment of depression among ethnic minority patients.